Dementia and shower (‘bath) time

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By Micha Shalev

Micha Shalev
Micha Shalev

One of the challenges in caring for someone with Alzheimer’s disease or another kind of dementia can be bath (or shower) time. Although some people with dementia don’t mind it, others are fearful and extremely resistive.

When a person is combative or resistive with a bath or a shower, there can be many causes for their behavior. Here are a few possible ones:

  • Embarrassment – If a person is concerned about privacy, bathing with someone else present could make them feel very uncomfortable and embarrassed.
  • Fear of water – Some people are afraid of water, whether it’s due to some traumatic incident or just increased anxiety. Others react negatively especially to a shower since they may have always grown up with the routine of a bath.
  • Lack of understanding – A person with middle or later stage dementia might not understand why you’re present, why you’re trying to take her clothes off or why she needs to be in the water and be washed. Understandably, this often causes significant resistance.

Occasionally, the person with dementia may become sexually inappropriate during bathing because he does not understand why you are assisting him. If he misinterprets your help, don’t yell at him. Simply explain: “Mr. Smith, I’m a nurses’ aide and I’m here to help you bathe today. Your wife will be here soon to visit you.”

Tips to improve bath time for the person with dementia

  1. Prepare first- Have the soap and shampoo ready, as well as a large, warm towel.
  2. Offer a choice between a bath or a shower – Some people might not have a strong preference, but for many, providing this choice (either to the person or to their family member who may be able to tell you what they have normally preferred) can improve the outcome. A lot of water in a tub may cause fear for some, while the spraying of a shower can make others anxious.
  3. Adjust the time of day -If you don’t know the person’s typical routine, find out from the family if he would like to start his day out with a shower or enjoy a bath before bed. That’s an important routine for many people, so honoring that for a person with dementia can go a long way toward a good outcome for both the person and the caregiver.
  4. Routine – As much as possible, stick to a routine, both as it relates to the time of day for a shower and the steps you use when helping the person bathe. Using a consistent caregiver to maintain this routine can also be very helpful to both the caregiver and the person with dementia.
  5. Ensure a warm room temperature – Ensure that the room is warm enough. A cold room plus water does not equal a positive experience.
  6. Encourage independence -If the person is able, ask them to wash themselves. Independence can restore a little bit of the dignity that’s lost when help is needed with bathing.
  7. Offer a caregiver of the same sex to provide the bath – If someone is embarrassed or becomes sexually inappropriate, offer a caregiver of the same sex to provide the shower.
  8. Large bath towels or shower capes – Provide a large bath towel or a shower cape to offer some privacy and warmth.
  9. Music – Use music in the bathroom to set the tone. Choose something the person with dementia enjoys and perhaps could join in the singing.
  10. Pain relief – Be aware of the possibility that your loved one is resistant to a shower because he’s in pain. If that appears to be the case, speak to the physician about trying pain medication prior to his bath time.
  11. Anti-anxiety medications – Some people experience so much anxiety that they might benefit from an anti-anxiety medication prior to their bath time. Be careful, however, that your goal is their comfort and that the medication would facilitate that comfort, rather than hasten your ability to cross a bath off your to-do list. A person with dementia still has the right to refuse a bath.
  12. Humor – Don’t forget to use humor. Humor is a great tool to reduce anxiety, increase comfort and distract from the task at hand.
  13. Spa-like atmosphere – Create a pleasant setting. Rather than have the shower room look like a hospital, place some art on the walls, music in the air and invest in towel heater for comfort.
  14. Doctor’s orders – Reminding a person who is resistive to bathing that the doctor wants them to take a bath might be helpful and temporarily direct his irritation toward the physician rather than you.
  15. Consider using a no-rinse soap and shampoo – If a longer bath time increases anxiety, you can shorten the process by using no-rinse products.
  16. Use different words- “Let’s wash up” – Some people react to specific words such as “shower time.” Try naming it “washing up” or “getting ready for the day.”
  17. Hire an experienced home health care aide – Some people respond better to someone who is not a family member when it comes to an intimate task like bathing.
  18. Try a different family member – It’s not unusual for different family members to receive different reactions. If your mother is extremely resistant to your help with a shower, perhaps your sister may have more success.
  19. Assist with sponge bathing if necessary – The ideal may be a shower or a bath, but you might still be able to accomplish the goal by sponge bathing. If bathing presents a constant battle, choose to set aside that battle and encourage your loved one to sponge bathe.

Other safety tips:

  • Offer a shower chair.
  • Ensure that the water temperature is not too hot.
  • Don’t leave a person with dementia alone in a shower or a bath.
  • Install grab bars.
  • Place non-slip decals or mats in the tub and on the floor.
  • Don’t store cleaning products in the bathroom.

Micha Shalev MHA CDP CDCM CADDCT is the co-owner of The Oasis at Dodge Park, Dodge Park Residential Care and The Adult Day Club at Dodge Park located at 101 and 102 Randolph Road in Worcester. He is holding a master degree in health care management and a graduate of the National Council of Certified Dementia Practitioners program, and well-known speaker covering Alzheimer’s and dementia training topics. He can be reached at 508-853-8180 or by e-mail at [email protected]. For more articles visit www.fiftyplusadvocate.com.